Patient's Query
Hello doctor,
I have had complete nasal obstruction for 28 months with total loss of smell and taste, affecting my appetite and quality of life. I wake with severe dry mouth from mouth breathing, and snoring is so loud that my wife sleeps separately. I have constant sinus pressure, facial pain, and thick yellow-green nasal discharge. I have tried multiple antibiotic courses, steroid sprays, and oral steroids without lasting improvement. My computed tomography (CT) scan showed bilateral nasal polyps filling both nasal cavities and ethmoid sinuses, and laboratory results showed eosinophils 780 cells per microliter.
Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern.
This presentation is typical of severe eosinophilic chronic rhinosinusitis with nasal polyps (eCRS). The high eosinophil count supports this, often linked to allergic or inflammatory pathways refractory to conventional medical therapy. The extent of polyp burden on computed tomography (CT) and symptom severity suggests failure of conservative treatments. I would suggest the following:
1. Referral to an ear, nose, and throat (ENT) specialist experienced in difficult chronic rhinosinusitis (CRS). Surgical intervention may be commonly recommended in such cases for symptom relief and to improve quality of life and olfaction.
2. Endoscopic sinus surgery (ESS) may be recommended to remove polyps and open sinuses, facilitating ventilation and drainage. It often results in symptomatic improvement, especially in cases where medical therapy fails.
3. Given the eosinophilic nature, biologics, for example, Dupilumab, Mepolizumab, may reduce polyp recurrence and control inflammation, especially if surgery alone is insufficient or contraindicated.
4. Post-operative medical management includes the use of topical corticosteroids and saline irrigations to prevent recurrence
5. Evaluation for obstructive sleep apnea (OSA) may be warranted given loud snoring and mouth breathing.
I would also recommend you to:
1. Discuss surgical options with your ear, nose, and throat (ENT) surgeon, highlighting your symptoms and treatment history.
2. Explore eligibility for biologic therapies as adjunct or alternative treatment.
3. Consider a sleep study if obstructive sleep apnea (OSA) is suspected.
Your condition requires comprehensive multidisciplinary management beyond antibiotics and steroids because of the chronic eosinophilic inflammatory nature and polyp burden, causing severe obstruction and loss of smell. Prompt specialist care can significantly improve your symptoms and quality of life.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
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Answered byDr. Bindia
Medically reviewed byiCliniq medical review team
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